What do we mean when we say that some Agents selling Health Insurance Marketplace policies have been engaging in Nefarious Activity?

I’m sure you’ve seen Marketing Commercials Stating that the Health Insurance Marketplace has Free Health Plans. They sure do for some individuals in certain counties of Florida that file their yearly Taxes in a specific income bracket.

President Biden passed the American Rescue Plan back in 2021 and ever since then, most individuals can sign up all year for a health plan because of the Special Election Period (SEP) for Individuals filing their Taxes under 150% of the Federal Poverty Level.

Since some consumers are able to get Free Health Plans, they can be enrolled into one without their knowledge. All the Agent needs is a Name and Birthday to be able to access anyone’s Health Insurance Marketplace Application.

Scam Phone Calls and Scammers on social media are on the rise. You may have filled out a survey online for something completely different, not realizing that in the Legalese of that survey, you were giving permission for that company to make your Health Care Decisions. This is just ONE example.

Some members answer the phone thinking its someone with the Health Insurance Marketplace or someone with our Agency reaching out to help them and it’s actually a scammer trying to get as much information as they can. Then they’re able to access your Health Insurance Marketplace Application and switch you from whatever Health Plan you’re in, to a Free one that they sell so they’re able to earn the commissions on that sale.

This leaves Consumers with interrupted Health Care. They could be changed into a health plan that has higher copays, deductibles, and a higher Maximum-Out-Pocket. Or their prescriptions might not be covered in that specific carrier’s Formulary (list of covered drugs).

There’s also Network issues to worry about. Some consumers who were in the middle of treatment for a serious illness have been unable to see their provider because the plan they were switched into is a network that provider does not contract with.

THIS IS WHY YOU NEED A REPUTABLE AGENT!!!

We have a system in place to track all our Member’s Marketplace Applications every month to ensure there is no Nefarious Activity happening to their Healthcare.

Thankfully the Centers for Medicare & Medicaid Services (CMS) passed a law before the 2024 Open Enrollment Season that every agent must have a Consent Form on file for 10 years that’s signed by the consumer that they gave their Agent permission to access their Health Insurance Marketplace Application.

If you talk to an agent and they do not have you sign a Consent Form (which can be sent digitally) before they access your Health Insurance Marketplace application, then they are committing a nefarious crime, and it needs to be reported to the Marketplace.

Please CLICK HERE for an example of a blank Consent Form that can be used to be compliant with this new law.